Psychologists gaining prescribing right?

[nancysinatra]

That's an extreme case... I don't think RxP's will be seeing those cases lol

It's not an extreme case. It's every case. When the patient walks in the door, they could have anything. How will you, as a psychologist, know that the person you're looking at doesn't have a previously unidentified heart condition? How will you know you're not looking at a brain tumor masquerading as a psychiatric condition? How will you know the patient doesn't have hepatitis C? Are you seriously telling me, you feel comfortable doing a medical screen on your patients so that you know none of these concerns are relevant?

Because guess what? No one is going to refer "simple" cases to you. If the patient walks in your door, they're yours. They're off the street. Good luck.

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[Pharmohaulic]

Ah. Got it. So what you're saying is that they're not going to be helping contribute to addressing the "shortage" of people who prescribe psychotropics? I guess it makes sense, then, for them to take the people who are straight forward, otherwise healthy and insured. You know, the kind who only need an SSRI and already have access to a PCP .

No they will help the shortage by taking the less extreme cases and freeing up the psychiatrists to see more complex issues Mr sarcastic... And BTW I don't want my pop who hasn't an ounce of psych knowledge prescribing my meds.. Id want a medically trained (2.5 years on top of a phd) trained psychologist any day!

 

[Pharmohaulic]

This is ridiculous. Why are we even discussing the possibility of psychologists having enough MEDICAL knowledge to refer. That bull**** statement of "extreme case" is a waste basket term thrown around for someone that doesn't know wtf medicine is.

Please, please, I urge you all psychiatrists, to NOT be nice, gentle, mellow, and understanding in this matter. There is NO GREY area, and it should not be created. Patients lives are at stake, not just our careers, but even more so, I repeat, human beings that can suffer greatly.

But there is a Grey area! Stop getting so defensive. You will never not be needed (we know this is the reason for the backlash). A medically trained psychologist (again that reads a PhD plus a 2.5 year medical masters; equivalent to a psychologist plus a PA degree) will free you up so you can handle more complex cases.

 

[Pharmohaulic]

It's not an extreme case. It's every case. When the patient walks in the door, they could have anything. How will you, as a psychologist, know that the person you're looking at doesn't have a previously unidentified heart condition? How will you know you're not looking at a brain tumor masquerading as a psychiatric condition? How will you know the patient doesn't have hepatitis C? Are you seriously telling me, you feel comfortable doing a medical screen on your patients so that you know none of these concerns are relevant?

Because guess what? No one is going to refer "simple" cases to you. If the patient walks in your door, they're yours. They're off the street. Good luck.

How does a mid level therapist know? And how do they know they aren't putting senseless effort into doing psychotherapy for something that actually is a medical problem?

How does a psych nurse practitioner do so?

If that's your attitude, let's ban anyone other than a high and mighty doctor.

 

[st2205]

No they will help the shortage by taking the less extreme cases and freeing up the psychiatrists to see more complex issues Mr sarcastic... And BTW I don't want my pop who hasn't an ounce of psych knowledge prescribing my meds.. Id want a medically trained (2.5 years on top of a phd) trained psychologist any day!

If you're taking the "less extreme" cases, those are patients coming from the PCPs and not the psychiatrists. And I'd submit to you that there being a psychiatrist "shortage" doesn't mean there's a shortage of people prescribing SSRIs.

 

[wesleysmith]

How does a mid level therapist know? And how do they know they aren't putting senseless effort into doing psychotherapy for something that actually is a medical problem?

We begin treatment with a referral to their PCP for their presenting complaints before beginning and generally coordinate care through ROIs (ideally) throughout to ensure the medically trained professionals have that side of things under control so we can do what we do.

 

[Extralong]

But there is a Grey area! Stop getting so defensive. You will never not be needed (we know this is the reason for the backlash). A medically trained psychologist (again that reads a PhD plus a 2.5 year medical masters; equivalent to a psychologist plus a PA degree) will free you up so you can handle more complex cases.

Don't worry, I am was not defensive, just clearly stating the fact that psychologists are not medical professionals and should absolutely NOT prescribe due to patient safety. And the term complex, extreme case or whatever else is a waste basket for people that lack proper medical knowledge.

I straight up tell congressmen/women, that there is no grey area for psychologists prescribing, that they do well at everything BUT medicine/prescribing. When they ask about NP and PAs, I say that with their medical and clinical training, that would be the only grey area.

I tell my friends(lawyers) that if a psychologist ends up in court for prescribing(in the states that they can prescribe), to call me and I will testify for free instead of my usual fee.

I will say this also: if you think I am aggressive, you have no idea, my colleagues are sitting at the edge of their stools, waiting to make an example of psychologists that are prescribing. And by example, I mean to include jail time, loss of license, loss of lots of money, etc.

Just a warning(obviously not a threat), becareful going that route, as you will be dealing many headaches; this thread is much more tame compared to what is happening in the really world.

 

[Jules A]

When they ask about NP and PAs, I say that with their medical and clinical training, that would be the only grey area.

Note to AMA most of the nurse practitioner programs no longer require any nursing experience let alone experience in psych if they are in the PMH-NP program. The rationale I have been given from faculty at multiple institutions is their focus is on retention of students and this includes the esteemed JH SON (error edit) . For some reason nurse anesthetists are still required to have experience aka a clue as to which end of the patient they need to insert the tube but not NPs.

 

[SmallBird]

Note to AMA most of the nurse practitioner programs no longer require any nursing experience let alone experience in psych if they are in the PMH-NP program. The rationale I have been given from faculty at multiple institutions is their focus is on retention of students and this includes the esteemed JHH. For some reason nurse anesthetists are still required to have experience aka a clue as to which end of the patient they need to insert the tube but not NPs.

Yes, but you still have to be a nurse! Meaning, having done anatomy and physiology, clinical rotations on medical and surgical floors, and an entrenchment within a strictly biomedical framework that strongly emphasizes medication safety.

I'm with extra long here. This has nothing to do with concerns over job security - I just don't think this is a safe plan.

 

[Doctor Bagel]

But there is a Grey area! Stop getting so defensive. You will never not be needed (we know this is the reason for the backlash). A medically trained psychologist (again that reads a PhD plus a 2.5 year medical masters; equivalent to a psychologist plus a PA degree) will free you up so you can handle more complex cases.

Admittedly a selfish aside, but why we would want this? The complex cases and the less complex cases often pay about the same, so with this paradigm we'd get paid the same for work that is much more challenging. Unless something else is given in this model like say the ability to work less for the same income, this seems like a recipe for physician burnout. Actually moving away from selfish motives, this burnout could affect patient care and the in the long run drive people away from being physicians.

 

[calvnandhobbs68]

Yes, but you still have to be a nurse! Meaning, having done anatomy and physiology, clinical rotations on medical and surgical floors, and an entrenchment within a strictly biomedical framework that strongly emphasizes medication safety.

I'm with extra long here. This has nothing to do with concerns over job security - I just don't think this is a safe plan.

Yeah you can go straight from your BSN to NP school and then when you're done with your 700 contact hours that usually involves shadowing a doctor or another NP you can get released into the wild with less actual required experience than an intern 6 months into residency. Top notch.

 

[calvnandhobbs68]

Admittedly a selfish aside, but why we would want this? The complex cases and the less complex cases often pay about the same, so with this paradigm we'd get paid the same for work that is much more challenging. Unless something else is given in this model like say the ability to work less for the same income, this seems like a recipe for physician burnout. Actually moving away from selfish motives, this burnout could affect patient care and the in the long run drive people away from being physicians.

It also sets the stage for decreasing reimbursements. Remember, insurance companies DON'T WANT to pay other providers equivalent to physicians, which is why they see NPs/PAs (and I guess now psychologists) as a cost cutting move. Even if that isn't the case now, it'll be what they'll be pushing for in the future. It'll start with "well you're not a physician so we don't need to reimburse you as much", then continue with "hey this guy was billing under the same code for less, so why should we reimburse you as much".

 

[Therapist4Chnge]

Please, please, I urge you all psychiatrists, to NOT be nice, gentle, mellow, and understanding in this matter. There is NO GREY area, and it should not be created. Patients lives are at stake, not just our careers, but even more so, I repeat, human beings that can suffer greatly.

It's been 14yrs since New Mexico granted prescribing rights to psychologists who pursue the additional training. I'd think that if human beings were at risk for, "suffering greatly" from psychologists prescribing, that we'd probably hear about it by now?

The hyperbolic rhetoric involved in this turf battle (let's call a spade a spade) needs to be acknowledged. If it truly was about reducing human suffering and protecting the public, then you'd go after the hack prescribers out there who continue to prescribe wrecklessly. Instead, those prescribers are protected through guild politics and they continue to put patients at risk.

 

[Therapist4Chnge]

I tell my friends(lawyers) that if a psychologist ends up in court for prescribing(in the states that they can prescribe), to call me and I will testify for free instead of my usual fee.

If I were to believe all of your posts and take them as fact, I'd think you'd be booked out all year testifying against the throngs of wreckless prescribing psychologists. How many times have you testified in such a case?

 

[st2205]

It's been 14yrs since New Mexico granted prescribing rights to psychologists who pursue the additional training. I'd think that if human beings were at risk for, "suffering greatly" from psychologists prescribing, that we'd probably hear about it by now?

I was going to discuss my belief that many are suffering already at the hands of midlevels and psychiatrists, but you did so for me below:

If it truly was about reducing human suffering and protecting the public, then you'd go after the hack prescribers out there who continue to prescribe wrecklessly. Instead, those prescribers are protected through guild politics and they continue to put patients at risk.

Yeah, and you don't hear about them, do you? So I wouldn't expect you'd hear much about a very small size of psychologists who are prescribing. People aren't all of the sudden going to be dropping dead left and right. I already fight a huge problem with my patients of balancing their locus of control with their belief in medication dictating the minute details of their lives. We continue to reinforce the false belief that we somehow need "more prescribers" and that there's a "shortage" of psychotropics out in society, and that there is such dire need for more prescriptions that we need to find shortcuts to getting the prescription pad in more providers' hands.

We complain about the idea of "med management" and everyone blasts psychiatry for spending a couple minutes with a patient then dumping meds on them, but then we reinforce this idea to the rest of the healthcare world indirectly saying this is exactly on what psychiatry is by putting out more providers with little training.

 

[Extralong]

If I were to believe all of your posts and take them as fact, I'd think you'd be booked out all year testifying against the throngs of wreckless prescribing psychologists. How many times have you testified in such a case?

Specifically, for prescribing psychologists, zero; I recently made myself available to this, as I have learned so much more since becoming active in politics. The process is not simple, there are three states with different regulations. I still have no idea exactly how patients report their issues against prescribing psychologists, though I remember that this was discussed in a different thread. My colleugue has been in court a few times in over the last 5-7 years. Not sure why you think that I'd be booked out.

This ramp up in legal action is more recent then it has been over the past several years, and I have been involved politically over the last several years, and wouldn't jump head first into court without doing my homework. Now that I have been involved for enough time to see the terribleness, I am clear with congressmen/women about my thoughts and the lawyers that would need me to testify that I would do it for free. I'm not here to prove anything, just want to alert others that this is much more serious compared to before.

 

[Pharmohaulic]

Yes, but you still have to be a nurse! Meaning, having done anatomy and physiology, clinical rotations on medical and surgical floors, and an entrenchment within a strictly biomedical framework that strongly emphasizes medication safety.

I'm with extra long here. This has nothing to do with concerns over job security - I just don't think this is a safe plan.

What aren't you people understanding that all of this stuff is including in the 2.5 years of medical training for a rx psychologist to!

 

[nitemagi]

What aren't you people understanding that all of this stuff is including in the 2.5 years of medical training for a rx psychologist to!

Because it's not included. RxPs don't get 2.5 years of real medical training. Check your sources. Look closer.

 

[Pharmohaulic]

Because it's not included. RxPs don't get 2.5 years of real medical training. Check your sources. Look closer.

I did I check led out the program in Hilo Hawaii, they do clinical rotations with physicians

 

[Extralong]

I did I check led out the program in Hilo Hawaii, they do clinical rotations with physicians

Nope.

"Students will be actively involved in consultation with physicians and/or appropriately credentialed psychologists regarding prescribing of psychoactive medications."

Furthermore:
"The Clinical Psychopharmacology Practicum components will be consistent with APA[American Psychological Association] Recommendations. "

https://hilo.hawaii.edu/catalog/ms-clinincal-psychopharmacology

Point to all of this, dangerous, unsafe practices that are in accordance to non-medical societal recommendations. I did not see anatomy, physiology, pathophys, clinical/physical examination, and other stuff that medical providers learn to be in medicine.

 

[Pharmohaulic]

Nope.

"Students will be actively involved in consultation with physicians and/or appropriately credentialed psychologists regarding prescribing of psychoactive medications."

Furthermore:
"The Clinical Psychopharmacology Practicum components will be consistent with APA[American Psychological Association] Recommendations. "

https://hilo.hawaii.edu/catalog/ms-clinincal-psychopharmacology

Point to all of this, dangerous, unsafe practices that are in accordance to non-medical societal recommendations. I did not see anatomy, physiology, pathophys, clinical/physical examination, and other stuff that medical providers learn to be in medicine.

Click on and read each class individually... I did and I saw instruction and training in labs, both ordering and interpreting, pharmacokinetics, physical exams, biochemistry, comorbid disorders so on and so forth

 

[st2205]

Click on and read each class individually... I did and I saw instruction and training in labs, both ordering and interpreting, pharmacokinetics, physical exams, biochemistry, comorbid disorders so on and so forth

And what's their general medical experience? How is general medicine learned?

 

[splik]

Click on and read each class individually... I did and I saw instruction and training in labs, both ordering and interpreting, pharmacokinetics, physical exams, biochemistry, comorbid disorders so on and so forth

we have looked and it and are telling you this is a joke. These requirements are very substandard. It is not appropriate to prescribe drugs having done an online course. Apparently the state legislature agreed which is why the bill for RxP in hawaii was defeated. 400 hours of watered down clinical experience is not acceptable. personally i am not against psychologists prescribing with appropriate training but this is not it. There is nothing stopping them doing a NP/PA course except the narcissitic injury of been an NP or PA.

 

[erg923]

we have looked and it and are telling you this is a joke. These requirements are very substandard. It is not appropriate to prescribe drugs having done an online course. Apparently the state legislature agreed which is why the bill for RxP in hawaii was defeated. 400 hours of watered down clinical experience is not acceptable. personally i am not against psychologists prescribing with appropriate training but this is not it. There is nothing stopping them doing a NP/PA course except the narcissitic injury of been an NP or PA.

Splik is right. It's weak. weak. Im not a big fan of this movement because I think its an answer to a not existent problem..and is cleary about money. The people who need the most help and/or who are the most underserved is clearly not who Rx Psycholgists will be seeing and taking care of. Some of the phram post-docs that are in person programs with residency and supervision requirements strike me as the bare minimum of acceptability here.

 

[Pharmohaulic]

we have looked and it and are telling you this is a joke. These requirements are very substandard. It is not appropriate to prescribe drugs having done an online course. Apparently the state legislature agreed which is why the bill for RxP in hawaii was defeated. 400 hours of watered down clinical experience is not acceptable. personally i am not against psychologists prescribing with appropriate training but this is not it. There is nothing stopping them doing a NP/PA course except the narcissitic injury of been an NP or PA.

It's not online and where is everyone getting this notion it's A course? It's in fact a WHOLE MASTERS DEGREE.

 

[Pharmohaulic]

And what's their general medical experience? How is general medicine learned?

So you really think they need to be slicing and dicing in order to prescribe?

 

[splik]

It's not online and where is everyone getting this notion it's A course? It's in fact a WHOLE MASTERS DEGREE.

i'm not going to argue with you about this because you clearly don't know what you're talking about and aren't interested in listening to anyone. it is an online course. why dont you contact them and ask them?

 

[calvnandhobbs68]

So you really think they need to be slicing and dicing in order to prescribe?

I don't even know what this means.

 

[st2205]

So you really think they need to be slicing and dicing in order to prescribe?

There's a reason why second year medical students (or even fourth year medical students) don't practice medicine. It's not because of deficiencies in completed coursework.

 

[Pharmohaulic]

i'm not going to argue with you about this because you clearly don't know what you're talking about and aren't interested in listening to anyone. it is an online course. why dont you contact them and ask them?

What program are u looking at? And the programs I look at are an entire masters degree.. What masters degree have you ever seen that's one course? When your find it please do let me know

 

[Pharmohaulic]

I don't even know what this means.

The "medical experience" you speak of, so assisting in surgery, delivering a baby etc.

 

[st2205]

The "medical experience" you speak of, so assisting in surgery, delivering a baby etc.

No, like being in a general medical clinic, an ER, or admitting people to a medical floor. You know, the places where you actually learn to recognize all these things you're saying you'll be trained to refer out on.

 

[Pharmohaulic]

There's a reason why second year medical students (or even fourth year medical students) don't practice medicine. It's not because of deficiencies in completed coursework.

Aka your implying residency, great I get your point. So for example, a psychiatrist can't be a psychiatrist before they do a residency because they need the mental health experience... I get it... But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

 

[Pharmohaulic]

No, like being in a general medical clinic, an ER, or admitting people to a medical floor. You know, the places where you actually learn to recognize all these you're saying you'll be trained to refer out on.

OK, but doing what specifically in these settings?

 

[Extralong]

Aka your implying residency, great I get your point. So for example, a psychiatrist can't be a psychiatrist before they do a residency because they need the mental health experience... I get it... But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

Wrong. Psychiatrists go through medical school before they enter residency. Thus a Psychiatrist is a physician and part of the medical profession.

 

[hamstergang]

But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

Except they did all that psychology/mental health training without any general medical knowledge. So no, it's not like they did a psychiatry residency already.

 

[nitemagi]

Aka your implying residency, great I get your point. So for example, a psychiatrist can't be a psychiatrist before they do a residency because they need the mental health experience... I get it... But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

You're presuming that the "masters" program is equivalent or sufficient to safely be practicing medicine in any form or specialty. We are saying it isn't.

People in these other clinical settings see a wide variety of other medical conditions, which are important to understand in relation to mental illness. There are medical mimics, for example. Seeing and treating meningitis, delirium with a variety of infections, neurological diseases, etc -- we learn to identify them, do specific examinations for them, and so can identify them when they come in the door masquerading as something else.

Psychopharmacology isn't really a thing. It's a construct as if drugs only affect the brain. They don't. They affect all organs of the body. Understanding how they all interact is imperative to understanding what drugs do, don't do, and the side effects they may cause. As well as how to treat in the context of any other co-existing medical conditions and the drugs being prescribed for those.

 

[calvnandhobbs68]

The "medical experience" you speak of, so assisting in surgery, delivering a baby etc.

It's hard to take statements about education seriously from someone who doesn't know the difference between different types of residencies.

 

[TexasPhysician]

But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

If this is how Rx psychologists think, I'm 110% against this.

NP/PA's are already causing enough problems. No need to add a 3rd group of people that are not only less knowledgeable, but feel overconfident despite the lack of knowledge.

MD's are already losing licenses due to PA/NP's overstepping with a Rx pad.

 

[calvnandhobbs68]

If this is how Rx psychologists think, I'm 110% against this.

NP/PA's are already causing enough problems. No need to add a 3rd group of people that are not only less knowledgeable, but feel overconfident despite the lack of knowledge.

MD's are already losing licenses due to PA/NP's overstepping with a Rx pad.

In terms of lawsuits or in terms of jobs?

 

[TexasPhysician]

In terms of lawsuits or in terms of jobs?

The medical board can revoke your medical license based on what your midlevel does.

The amount of supervision to protect yourself can be immense. The problem is that clinics do not want to dedicate hours each week to physicians teaching, supervising, and reviewing documentation/prescribing of midlevels. They want physicians to just sign off and collect a check, but the wrong midlevel can destroy your career.

 

[Pharmohaulic]

It's hard to take statements about education seriously from someone who doesn't know the difference between different types of residencies.

I was giving examples of different specific tasks I thought this individual was implying psychologists should participate in. I was not trying to name the different specialties... So invalid point.

 

[Pharmohaulic]

If this is how Rx psychologists think, I'm 110% against this.

NP/PA's are already causing enough problems. No need to add a 3rd group of people that are not only less knowledgeable, but feel overconfident despite the lack of knowledge.

MD's are already losing licenses due to PA/NP's overstepping with a Rx pad.

Overconfident would be to NOT admit psychologists need me biological and physiological training. It was never argued they do not need more training.

 

[Pharmohaulic]

The medical board can revoke your medical license based on what your midlevel does.

The amount of supervision to protect yourself can be immense. The problem is that clinics do not want to dedicate hours each week to physicians teaching, supervising, and reviewing documentation/prescribing of midlevels. They want physicians to just sign off and collect a check, but the wrong midlevel can destroy your career.

What mid-level? Ohh right right, the Nurse Practitioners who have gotten independent rights to practice in nearly every state WITHOUT even having to collaborate with you? That defeats the point of a mid-level and if you ask me this is the real problem everyone should be concerned with.

 

[smalltownpsych]

If this is how Rx psychologists think, I'm 110% against this.

NP/PA's are already causing enough problems. No need to add a 3rd group of people that are not only less knowledgeable, but feel overconfident despite the lack of knowledge.

MD's are already losing licenses due to PA/NP's overstepping with a Rx pad.

I am pretty sure that this individual is not a psychologist. Troll appears more likely.

 

[erg923]

Overconfident would be to NOT admit psychologists need me biological and physiological training. It was never argued they do not need more training.

Why is it so important for you to try to convince physicians this is a good idea?

 

[TexasPhysician]

the Nurse Practitioners who have gotten independent rights to practice in nearly every state WITHOUT even having to collaborate with you? .

Incorrect. Supervision required where I am located.

 

[Doctor Bagel]

Incorrect. Supervision required where I am located.

It's independent practice in about half of the states. NPs have 100% independent practice in my state. My hospital requires some light oversight, but it's pretty minimal.

 

[Pharmohaulic]

It's independent practice in about half of the states. NPs have 100% independent practice in my state. My hospital requires some light oversight, but it's pretty minimal.

That should not be happening!

 

[takeeacy]

400 hours of clinical contact sounds like a lot, but that's about what a medical student may get in less than 2 months. Anyone in the medical field knows that a medical student with 2 months of clinical experience is near useless with their clinical judgment, let alone an intern with 400 hours of clinical contact in residency (5 weeks) or even 700 (less than a season).

I want to add that I did my undergrad at a top 3 clinical psychology university (according to the USWNR however useless it is), and I remember being caught up in the idea that psychologists should prescribe these "relatively simple medications" for "straightforward conditions." Now after completing medical school and starting residency as an intern, I can see that it is definitely not true. Side effect profiles for almost any psychiatric drug are extremely far ranging (probably more so than most other drugs) and require significant medical knowledge and experience to handle.